91 4 Diabetes-tuberculosis comorbidity in a low-income setting Key Words: Diabetes; Tuberculosis; Comorbidity; Non-communicable diseases; Treatment outcome; Mortality; Low- and middle-income countries Research in Context Evidence before this study We searched PubMed on the 20th of May 2022 using the search terms "diabetes"[Title/ Abstract] AND "tuberculosis"[Title/Abstract] AND "comorbidity"[Title/Abstract] without date and language restrictions. There were no articles describing diabetes–tuberculosis co-morbidity in Eswatini. A further search generated one article, which showed a 6% prevalence of DM among HIV patients. Eswatini has a high burden of tuberculosis and HIV, with an increasing burden of diabetes. Studies from other locations indicate a rising burden of diabetes mellitus in low- and middle-income countries with a high burden of tuberculosis. Diabetes mellitus increases the risk of tuberculosis disease with unfavourable outcomes in those receiving treatment for tuberculosis, directly limiting tuberculosis control efforts. Added value of this study This study describes outcomes of blood glucose screening in patients receiving tuberculosis treatment, predictors of elevated baseline blood glucose and unfavourable treatment outcomes. We observed a higher prevalence of elevated baseline blood glucose in patients commencing tuberculosis treatment than the general population, slightly higher in males and those with a reactive HIV status. A family history of diabetes mellitus and reactive HIV status predicted elevated baseline blood glucose. Three-quarters of the patients had a favourable tuberculosis treatment outcome, and death was the most common unfavourable outcome. Hypertension and unemployment were predictors of unfavourable treatment outcomes, while high school education was protective. Implications of all the available evidence The higher prevalence of elevated baseline blood glucose in tuberculosis patients indicates the need to implement the framework for collaborative action on TB and comorbidities, as the World Health Organisation advocates. This can fast-track the timely diagnosis and treatment of diabetes and other non-communicable diseases among tuberculosis patients to limit unfavourable treatment outcomes. Additional evidence is required to identify and address the causes of death among tuberculosis patients apart from HIV.
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